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PubMed1979

[Anal symptoms of gastro-intestinal diseases].

In most cases the ano-cutaneous clinical symptoms correlated to diseases of the gastro-intestinal tract are not specific (erythema, itching, wounds or scarring). However in the following diseases occasional dermatological lesions may directly contribute to their diagnosis: in Crohn's disease, tuberculosis of bowel, chronic entamoebiasis and bilharziosis, the skin lesions of the anal area have the same histological structure as the gut lesions. Perianal fistulas and ulcers are frequent in Crohn's disease especially if there is a colonic and rectal spreading; they respond badly to steroid therapy and are often correlated with a worse prognosis. Perianal specific lesions occur often in oxyuriasis in children, in candidiasis of the digestive tract, in systemic aphthosis and in some malignancies. In other gastro-intestinal disturbances, the dermatological and features are less specific and can only be suggestive: iatrogenic and microbial diarrheas, side-effects of laxatives, proctological diseases. It has to be emphasized that pruritus ani is only induced by deeper lesions when they spread to the perianal skin. In proctological practice, contact dermatitis by sensitivity to anaesthetics or suppository balsams (Peruvian balsam), itching or burning atrophy by topical steroid abuse, non-diagnosed fungal (candidiasis), bacterial (erythrasma) or psoriatic intertrigos (flexural psoriasis) may sometimes explain the failure of therapy.

Adult↗
PubMed1979

Gracilis muscle transplant for delayed healing of the perineal wound.

Delayed perineal wound healing frequently complicates a proctocolectomy in patients with inflammatory bowel disease. In almost half of the patients the evicerated pelvic space is not closed six months after surgery. Conventional surgery is very unsuccessful in the treatment of this persistent perineal fistula. A new technique is described using the transposition of the gracilis muscle to fill the perineal cavity. It is an easy procedure that solves a difficult problem.

Fistula↗
PubMed1980

[Ulcerative colitis and Crohn's colitis. Medical or surgical treatment].

Colectomy with ileorectal anastomosis was performed in 47 patients affected by ulcerative colitis and Crohn's colitis. These two forms of "aggressive idiopathic colitis" present the same problems of therapy from both the pharmacological and the surgical point of view. The topical employment of antiphlogistic steroids and sulphasalazine by daily retention enemas caused a regression of proctitis and allowed a safe ileorectal anastomosis. After the surgical procedure a protective treatment of the rectal mucosa was prosecuted with minimal dosages of the same antiphlogistic drug by daily minienemas. Betametasone in aqueous solution have proved, among the antiphlogistic steroids, to be very suitable for a topical action without side-effects in the long time. The association of topical treatment and surgery is particularly indicated for those patients who cannot recover with medical therapy alone, as it enables them to recover and return to a normal life. The opportunity for colectomy is so much greater as it is possible, as a rule, to spare the rectum and protect the ileorectal anastomosis by means of a topical therapy without limitations of time. Therefore the surgical indication should not be delayed whenever the medical treatment by systemic administration of steroids, sulphasalazine and immunosuppressors is unable to prevent the evolution of aggressive idiopathic colitis to a chronic and seriously invalidating disease.

Anti-Inflammatory Agents↗
PubMed1980

On the efficacy of ready-made-up commercially available salicylazosulphapyridine enemas in the treatment of proctitis, proctosigmoiditis and ulcerative colitis involving rectum, sigmoid and descending colon.

To investigate efficacy and possible side effects, double-blind studies were carried out using 3% salicylazosulphapyridine enemas and appropriate placebo enemas. In a first study involving peranal therapy along, the success rate was 73%; in a second study employing a combination of oral and peranal medication, the success rate was 75%. This shows that the efficacy of the peranal form of administration is comparable to that obtained with oral medication. No side effects were observed throughout the period of observation of this study.

Administration, Oral↗